Provider Demographics
NPI:1609294305
Name:DORNBIER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DORNBIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12129 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8287
Mailing Address - Country:US
Mailing Address - Phone:515-400-3550
Mailing Address - Fax:
Practice Address - Street 1:12129 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8287
Practice Address - Country:US
Practice Address - Phone:515-400-3550
Practice Address - Fax:515-400-3551
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.065964208600000X, 208800000X
IL036147483208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery